The integration of primary care and childhood cancer survivorship care: a scoping review

Julia Stal; Sarah E Piombo; Lynn Kysh; Dalia Kagramanov; David R Freyer; Barbara J Turner; Susanne Hempel; Kimberly A Miller

doi:10.1007/s11764-022-01296-8

The integration of primary care and childhood cancer survivorship care: a scoping review

J Cancer Surviv. 2022 Dec 19. doi: 10.1007/s11764-022-01296-8. Online ahead of print.

Authors

Julia Stal^#¹, Sarah E Piombo^#², Lynn Kysh³, Dalia Kagramanov², David R Freyer^{2

4

5

6}, Barbara J Turner^{7

8}, Susanne Hempel^{2

9}, Kimberly A Miller^{2

10}

Affiliations

¹ Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. jstal@usc.edu.
² Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
³ Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, USA.
⁴ Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
⁵ Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.
⁶ USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
⁷ Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
⁸ Gehr Family Center for Health Systems Research and Innovation, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
⁹ Southern California Evidence Review Center, University of Southern California, Los Angeles, USA.
¹⁰ Department of Dermatology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.

^# Contributed equally.

PMID: 36534343
DOI: 10.1007/s11764-022-01296-8

Abstract

Purpose: This scoping review describes existing care models that integrate primary care and childhood cancer survivorship care, examines the effectiveness of these models, and characterizes barriers and facilitators to their integration.

Methods: A systematic search (PubMed®, CINAHL®, Embase®) was conducted to identify citations which were evaluated against inclusion criteria using the PICOTTS framework. The PRISMA-ScR extension for scoping reviews was used to report review findings (protocol https://osf.io/92xbg ).

Results: Twenty-three studies were included. Three care models integrating primary care and childhood cancer survivorship care were identified: consultative shared care in a primary care setting (N = 3); longitudinal shared care (N = 2); and PCP-led care employing a survivorship care plan (N = 5). While many described risk-adapted care, few used risk stratification approaches to inform care. Measures of model effectiveness varied, with discrepant findings regarding late effects detection in PCP-led approaches. The most frequently cited barriers and facilitators reflected provider- and system-level factors (PCP knowledge/experience identified as greatest barrier (N = 11); clinical information from oncologist identified as greatest facilitator (N = 9)).

Conclusions: Identified models depended on PCP knowledge and healthcare system coordination, and studies suggested the need for strong oncologic involvement in follow-up care. Improved training for PCPs and the coordinated transfer of clinical information could facilitate their involvement in such care. Overall, standardized measures of effectiveness are needed to deliver optimal childhood cancer survivorship care.

Implications for cancer survivors: The literature revealed three care models defined by SCP use, provider involvement, and continuity of care, with several studies recommending oncologic involvement in follow-up care for high-risk survivors.

Keywords: Childhood cancer; Models of care; Primary care; Scoping review; Survivorship.

Publication types

Review